Provider Demographics
NPI:1659422319
Name:PHRYDAS, PETER ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ARTHUR
Last Name:PHRYDAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FELTON PL # B
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2152
Mailing Address - Country:US
Mailing Address - Phone:770-382-3536
Mailing Address - Fax:770-382-1915
Practice Address - Street 1:16 FELTON PL # B
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2152
Practice Address - Country:US
Practice Address - Phone:770-382-3536
Practice Address - Fax:770-382-1915
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0074691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA101642Medicaid
GA9184123OtherDORAL GA MEDICAID